title: The potential impact of routine testing of individuals with HIV indicator diseases in order to prevent late HIV diagnosis.
abstract: BACKGROUND
  The aim of our work was to evaluate the potential impact of the European policy of testing for HIV all individuals presenting with an indicator disease, to prevent late diagnosis of HIV. We report on a retrospective analysis among individuals diagnosed with HIV to assess whether a history of certain diseases prior to HIV diagnosis was associated with the chance of presenting late for care, and to estimate the proportion of individuals presenting late who could have been diagnosed earlier if tested when the indicator disease was diagnosed.
  
  
  METHODS
  We studied a large cohort of individuals newly diagnosed with HIV infection in 13 counselling and testing sites in the Lazio Region, Italy (01/01/2004-30/04/2009). Considered indicator diseases were: viral hepatitis infection (HBV/HCV), sexually transmitted infections, seborrhoeic dermatitis and tuberculosis. Logistic regression analysis was performed to estimate association of occurrence of at least one indicator disease with late HIV diagnosis.
  
  
  RESULTS
  In our analysis, the prevalence of late HIV diagnosis was 51.3% (890/1735). Individuals reporting at least one indicator disease before HIV diagnosis (29% of the study population) had a lower risk of late diagnosis (OR = 0.7; 95%CI: 0.5-0.8) compared to those who did not report a previous indicator disease. 52/890 (5.8%) late presenters were probably already infected at the time the indicator disease was diagnosed, a median of 22.6 months before HIV diagnosis.
  
  
  CONCLUSIONS
  Our data suggest that testing for HIV following diagnosis of an indicator disease significantly decreases the probability of late HIV diagnosis. Moreover, for 5.5% of late HIV presenters, diagnosis could have been anticipated if they had been tested when an HIV indicator disease was diagnosed.However, this strategy for enhancing early HIV diagnosis needs to be complemented by client-centred interventions that aim to increase awareness in people who do not perceive themselves as being at risk for HIV.
authors.affiliation: National Institute for Infectious Diseases "L, Spallanzani" (IRCCS), Via Portuense 292, Rome 00149, Italy. enrico.girardi@inmi.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Scognamiglio
authors.forename: Giacomina
authors.initials: G
authors.lastname: Chiaradia
authors.forename: Gabriella
authors.initials: G
authors.lastname: De Carli
authors.forename: Massimo
authors.initials: M
authors.lastname: Giuliani
authors.forename: Claudio Maria
authors.initials: CM
authors.lastname: Mastroianni
authors.forename: Stefano
authors.initials: S
authors.lastname: Aviani Barbacci
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Buonomini
authors.forename: Susanna
authors.initials: S
authors.lastname: Grisetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sampaolesi
authors.forename: Angela
authors.initials: A
authors.lastname: Corpolongo
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Orchi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Puro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Ippolito
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018791:CD4 Lymphocyte Count; D057210:Delayed Diagnosis; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult